Provider Demographics
NPI:1891134300
Name:RODRIGUEZ STEWART, VIVIANA M (MS, CCC-SLP)
Entity Type:Individual
Prefix:
First Name:VIVIANA
Middle Name:M
Last Name:RODRIGUEZ STEWART
Suffix:
Gender:F
Credentials:MS, CCC-SLP
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Mailing Address - Street 1:4755 GRAMERCY OAKS DR APT 119
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75287-5337
Mailing Address - Country:US
Mailing Address - Phone:787-385-5517
Mailing Address - Fax:
Practice Address - Street 1:4825 ALLIANCE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75093-5504
Practice Address - Country:US
Practice Address - Phone:787-385-5517
Practice Address - Fax:469-606-1383
Is Sole Proprietor?:No
Enumeration Date:2013-06-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR2092235Z00000X
TX108273235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist